Journals Watch - Statins, aspirin, NRT and dummies

Some analyses have suggested that statins reduce the risk of developing cancer. This large meta-analysis found statins neither increase nor decrease the risk of cancer or cancer mortality.

All the different statins were included in this analysis. There were no statistically significant differences between patients receiving statins versus controls for cancers of the breast, prostate, GI tract, colon, respiratory tract or melanoma.

Caution for aspirin use

Stroke 2006; 37: 129-33

GPs are prescribing aspirin more frequently for primary prevention of cardiovascular disease. This small study shows an increased risk of death in patients who took aspirin before having an intracerebral haemorrhage.

Patients taking aspirin had a 2.5 increased relative risk of dying in the first three months after the stroke compared to those who did not take aspirin or warfarin.

Safety of nicotine replacement therapy

Tob Control 2005; 14: 416-21

There has been some concern that nicotine replacement therapy (NRT) may be associated with an increased risk of MI, stroke or even death.

This analysis used a computerised UK general practice database involving over 33,000 patients taking NRT. The use of NRT was not found to be associated with any increase of MI, stroke or death over a 2.6 year follow-up period.

Antidepressants take two months to work

Am J Psychiatry 2006; 163: 28-40

Most of us advise patients with depression to expect a response to their antidepressant within two weeks. This study has shown that we need to be more patient. Nearly 3,000 depressed patients were given citalopram, initially at a dose of 20mg and monitored over a 12-week period.

Of those who responded to treatment (approximately half), 56 per cent did so after eight weeks of treatment. Those more likely to respond had less severe depression, were better educated, higher paid and not living alone.

Dummy use and sudden infant death

BMJ 2006; 332: 18-21

This case-control study from the US echoes results of a meta-analysis published last year - the use of a dummy is associated with a substantial reduction in the risk of sudden infant death syndrome (SIDS). The adjusted-odds ratio for SIDS associated with using a dummy was 0.08.

The use of a dummy also reduced the adverse effects of a prone sleep position or sleeping with a mother who smoked. It is unclear how dummies help - the handle on the dummy may change the configuration of the airway passage or sucking may enhance pathways controlling the potency of the upper airway. The use of dummies may well be an effective strategy for public health intervention in the future.

Beware of using clarithromycin

BMJ 2006; 332: 22-4

Previous studies have shown that the use of clarithromycin may be beneficial in patients with CHD by eradicating Chlamydia pneumoniae which is present in atherosclerotic plaques.

This randomised multicentre trial from Denmark has actually shown the opposite - that the use of clarithromycin in the short term for patients with stable CHD may cause significantly higher cardiovascular mortality.

No recommendations have been suggested but it may be sensible to consider alternative antibiotics for CHD patients.

- Dr Newson is a GP in the West Midlands and a member of our team who review the journals

INFORMING PATIENTS

Cancer risk and cancer mortality are not affected by statin use.

Taking aspirin before having an intracerebral haemorrhage increases a patient's risk of death.

Forget lowering cholesterol or losing weight to reduce your patients' cardiovascular risk - consider the state of their teeth. This study has provided further evidence linking periodontal to cardiac disease.

It has shown that a radical treatment for severe gum disease involving extraction of all a person's teeth could lower cardiovascular risk.

The authors have speculated that chronic periodontitis is likely to induce a systemic inflammatory and prothrombotic state which thereby increases the risk of myocardial infarction (MI).